How cancer treatment can affect fertility

The main treatments for cancer are chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy. These can affect your fertility in different ways. Treatments can damage or affect:

  • the eggs in the ovaries
  • the pituitary gland and hormone production
  • the womb, cervix or ovaries.

Doctors may not be able to predict exactly how your fertility will be affected. But your age and the planned treatment can help give them an idea. Sometimes, it may be possible to reduce the effects of treatment on your fertility.

Some women find their periods stop during treatment and they might have some menopausal symptoms. These may better after treatment. But sometimes the ovaries are permanently damaged and periods don’t come back. In this case, the symptoms of the menopause will continue.

Cancer treatments may harm a developing baby. Even if your periods stop during treatment you might still be able to get pregnant. It is important to use contraception during cancer treatment and for a time after.

Cancer treatments and fertility

The main treatments for cancer are chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy. These can affect your fertility in different ways.

Treatments can damage or affect:

  • the eggs in the ovaries
  • the pituitary gland and hormone production
  • the womb, cervix or ovaries.

Doctors may not be able to predict exactly how your fertility will be affected. But your age and the planned treatment can help give an idea of your individual risk. Sometimes, it may be possible to reduce the effects of treatment on your fertility.


Menopausal symptoms

Some women find their periods stop during cancer treatment and come back afterwards. During treatment they might have some menopausal symptoms. These may get better after treatment.

But sometimes cancer treatment causes permanent damage to the ovaries and periods don’t come back. This is called early menopause or premature ovarian insufficiency (POI). In this case, the symptoms of the menopause will continue.

Coping with menopausal symptoms can be hard. Ask your cancer doctor or specialist nurse for advice about treatments that can help. There are also organisations that support women who have an early menopause.


Contraception during cancer treatment

Cancer treatments may harm a developing baby. Even if your periods stop during treatment you might still be able to get pregnant. So it’s important to use contraception during cancer treatment and for a time after.

It’s difficult to predict when fertility will recover. This could happen without you being aware of it. If you don’t want to have a child, you should keep using contraception unless doctors tell you that your infertility is permanent.

If you’ve had breast cancer, your doctor may advise you not to use contraception that contains hormones, such as the contraceptive pill. This is because the hormones could encourage breast cancer cells to grow. Your cancer doctor or specialist nurse will give you more advice about this.


Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It reduces the number of eggs stored in your ovaries and can mean fewer or no eggs are released. Your periods may become irregular or stop for a while (temporary infertility). It may take up to two years for them to come back again.

Chemotherapy sometimes causes permanent infertility and an early menopause. The risk of infertility depends on the following:

  • Your age – Younger women are more likely to remain fertile and their periods are more likely to come back. Women over 35 already have a lower chance of getting pregnant as the number and quality of the eggs has started to decline naturally. The older you are and the closer you are to your natural menopause, the higher the risk of infertility.
  • The drugs you have – Some chemotherapy drugs have a higher risk of causing permanent infertility. Others have little or no risk. We have more information about individual chemotherapy drugs.
  • The dose of the drug – Higher doses of chemotherapy, especially before stem cell transplants, are more likely to affect fertility.

Chemotherapy can reduce the number of eggs you have. So even if your periods do come back, your menopause may start 5 to 10 years earlier than it would have done naturally. This means you have a shorter time to try to get pregnant.

In some cases, it may be possible to choose a chemotherapy treatment that is less likely to affect fertility. Or some women may be given a type of hormone therapy during chemotherapy to try to protect the ovaries. If you want to have children in the future, your cancer doctor can explain if these are options for you.


Radiotherapy and fertility

Radiotherapy uses high-energy rays to destroy cancer cells. It can cause fertility problems by:

  • affecting the eggs
  • damaging the ovaries, womb or pituitary gland
  • reducing hormones (oestrogen and progesterone).

Radiotherapy to the pelvis

Radiotherapy given directly to the ovaries and womb will cause permanent infertility. Your menopause will start and you won’t be able to get pregnant.

Radiotherapy to other areas of the pelvis may indirectly damage the ovaries or the womb. This may stop the ovaries working for a short time or permanently. If the ovaries recover after treatment, you may be able to get pregnant. If the womb is damaged, you may be able to get pregnant but there will be a higher risk of miscarriage or premature birth.

Your risk of infertility depends on the dose of radiotherapy you have and your age. The risk increases as you get older. There’s a higher risk of infertility when you have chemotherapy with radiotherapy (chemoradiation).

Sometimes it’s possible to protect the ovaries with a lead shield during radiotherapy. Or in some cases, surgeons can move the ovaries out of the way before starting radiotherapy. This is called ovarian transposition. It is usually done by keyhole surgery.

Total body irradiation (TBI)

TBI is radiotherapy given to the whole body before a donor stem cell or bone marrow transplant. This usually causes permanent infertility. Your cancer specialist will talk to you about this before you agree to treatment.

Radiotherapy to the brain

Radiotherapy to the pituitary gland at the base of the brain can sometimes affect fertility. The pituitary gland releases hormones called gonadotrophins that stimulate the ovaries.

If your pituitary gland has been affected, the ovaries may stop producing hormones and releasing eggs. This can happen some months or years after radiotherapy. Your periods may stop and you may not be able to get pregnant. This is not because you have run out of eggs, but because your ovaries aren’t being stimulated to release them.

Radioactive iodine

Radioactive iodine is a type of radiotherapy used to treat thyroid cancer. It doesn’t usually affect fertility, although your periods may stop for a while after treatment.

Radiotherapy to areas of the body not mentioned here won’t cause infertility.

It was a difficult and confusing time for us, because at the time of diagnosis we were young, so we hadn’t really thought about children and family.

Neesha


Surgery

Operations that can affect fertility are:

  • having your womb removed (hysterectomy)
  • having your ovaries removed
  • surgery to the cervix
  • surgery to the pituitary gland.

Surgery to the womb or ovaries

For some cancers, surgery involves removing the womb (a hysterectomy), the ovaries, or both.

If the surgeon removes your womb or both your ovaries, you won’t be able to get pregnant. However, if only one ovary is removed and you still have your womb, the remaining ovary will continue to release eggs and hormones. You may still get pregnant naturally.

Having one ovary removed is sometimes called fertility-conserving surgery. This may be an option for young women with germ cell tumours of the ovary and some other types of ovarian cancer.

Surgery to the cervix

Occasionally, women with a very small, early cancer of the cervix can have an operation called a trachelectomy. This operation removes most of the cervix but leaves the womb and ovaries. It may be possible to become pregnant and have a baby afterwards, although there is a higher risk of miscarriage or premature birth.

Trachelectomy is a specialised operation and it’s only done in a few hospitals in the UK.

Surgery to the pituitary gland

Surgery may be used to remove a tumour in the pituitary gland at the base of the brain. The pituitary gland releases hormones called gonadotrophins that stimulate the ovaries.

Surgeons try to leave some of the gland when removing the tumour, but this isn’t always possible. When the whole pituitary gland is removed, this affects your hormones and your ovaries will stop releasing eggs. Your periods may stop and you won’t be able to get pregnant. This is not because you have run out of eggs, but because your ovaries aren’t being stimulated to release them.


Hormonal therapy

For some types of cancers, hormones encourage the cancer cells to grow. Your cancer doctor may treat you with a hormonal therapy. This treatment reduces the levels of hormones in your body or blocks their effect on cancer cells. It is often used to treat breast cancer. Hormonal therapy can affect your fertility but this is usually temporary. The drugs most commonly used are goserelin (Zoladex®) and tamoxifen.

Your periods may change or stop while you are taking these drugs. But it’s still important to use contraception to prevent a pregnancy. This is because there’s a risk these drugs may harm an unborn baby.

Goserelin will stop your periods but they usually come back again after you finish taking it. Tamoxifen can make your periods irregular or stop, but they usually start again a few months after you’ve finished taking it. Tamoxifen is often taken for at least five years.

Most women will get menopausal side effects such as hot flushes while taking goserelin or tamoxifen. These stop after you finish taking the drug. Some women go through their natural menopause during treatment. If this happens, you may not be aware of it because the side effects of the drugs are similar to the symptoms of the menopause.


Targeted therapy

Targeted therapies are a newer type of cancer treatment. They are also called biological therapies and are used to treat many different cancers. It’s not yet known exactly what effect they may have on fertility. Some targeted treatments have been shown to affect fertility. If you are treated with a targeted therapy, your cancer doctor can talk to you about possible risks to your fertility.

Back to Fertility in women

What is fertility?

Fertility in women means being able to get pregnant and give birth to a baby. Cancer and cancer treatment can affect this.

Preserving your fertility

You may be able to freeze eggs, embryos or ovarian tissue before you start your cancer treatment.

Getting support

You may find it helpful to talk to someone about any fertility worries.